A60 .043). The study, though conducted with a small sample of patients <strong>and</strong> for a short period of observation, nevertheless provides preliminary evidence of the efficacy of a short (4 hours) <strong>ACT</strong> intervention in preventing sick-leave <strong>and</strong> me<strong>di</strong>cal access in people with chronic pain. Moreover, further stu<strong>di</strong>es are needed to clarify the putative change processes, also analyzing the separate contribution of the <strong>di</strong>fferent therapeutic components. McCracken et al (49) followed 108 chronic pain patients with a long history of treatment (average 10 years) through an <strong>ACT</strong>-based 3-4 weeks residential treatment program. In this multi-<strong>di</strong>sciplinary <strong>and</strong> intensive protocol physiotherapists, occupational therapists, nurses, physicians, <strong>and</strong> psychologists all worked together on an <strong>ACT</strong>based program delivered approximately 6 hours a day, with daily in<strong>di</strong>vidual psychological sessions. The program included exposures <strong>and</strong> explicitly targeted the role of feelings <strong>and</strong> thoughts as reasons for action (or inaction), without attempting to change the form or reduce the frequency of the feared internal experiences. In the run-in period measures improved from initial assessment to pretreatment on average only by 3% (average of 3.9 month wait), but improved on average by 34% following treatment. 81% of these gains were maintained at 3 months follow up. Further, positive changes in acceptance of pain measured by the CPAQ co-varied with improvement in depression, pain related anxiety, physical <strong>di</strong>sability, psychosocial <strong>di</strong>sability, <strong>and</strong> the ability to st<strong>and</strong>. Positive outcomes were also seen in a timed walk, decreased me<strong>di</strong>cal visits, daily rest due to pain, pain intensity, <strong>and</strong> decreased pain me<strong>di</strong>cation use. Although there was no r<strong>and</strong>omization to treatment, the waiting period of each subject before treatment worked as his/her own comparison con<strong>di</strong>tion. McCracken et al (50) also compared the impact of an intensive <strong>and</strong> multi-<strong>di</strong>sciplinary three-week treatment (total time 80h, inclu<strong>di</strong>ng principles of exposure, acceptance, cognitive defusion, mindfulness, <strong>and</strong> values based approaches) with two groups of highly <strong>di</strong>sabled (n = 53) <strong>and</strong> st<strong>and</strong>ard patients (n = 234) with chronic pain. The highly <strong>di</strong>sabled patients showed significant changes (t-test p
G Ital Med Lav Erg 2011; 33:1, Suppl A, Psicol http://gimle.fsm.it found at post-intervention (F(1,170) = 50.16, p